Cutaneous field stimulation with disposable and rechargeable components

ABSTRACT

A CFS system includes self-adhesive, disposable pads. Each pad is combined with a sealed, cleanable battery/controller pod and then placed on the body where needed. The battery/controller pod preferably has wireless capability, such as Bluetooth® capability. The patient can download an application to a smartphone or similar mobile device to control the pods.

REFERENCE TO RELATED APPLICATIONS

The present application claims the benefit of U.S. Provisional PatentApplication No. 61/767,509, filed Feb. 21, 2013. Related subject matteris disclosed in U.S. Patent Application Publication No. 2010/0274327 A1and in U.S. Pat. Nos. 8,086,322 and 8,386,005. The disclosures of all ofthe above applications and patents are hereby incorporated by referencein their entireties into the present disclosure.

FIELD OF THE INVENTION

The present invention is directed to cutaneous field stimulation andmore particularly to such stimulation with disposable and rechargeablecomponents.

DESCRIPTION OF RELATED ART

Electroanalgesic therapies are known nonpharmacologic alternatives toconventional analgesic drugs for the management of acute and chronicpain. For example, percutaneous electrical nerve stimulation (PENS) is aknown form of electroanalgesic therapy typically used for the treatmentof intractable pain associated with chronic low back pain syndrome bystimulating the spinal cord (SCS) using electrodes implantedpercutaneously into the epidural space as a trial before a morepermanent total implantation of an SCS System. The term PENS has alsobeen used to describe a technique for inserting 32-gauge acupunctureneedles into soft tissues or muscles to electrically stimulateperipheral nerve fibers in the sclerotomal, myotomal, or dermatomaldistribution corresponding to a patient's pain symptoms. Medical deviceshaving arrays of percutaneous electrodes that utilize microstructureneedles, which are less invasive than deeper-penetrating acupunctureneedles, have also been used for delivering PENS. The microstructureneedles provide sufficient penetration to overcome the electricalimpedance of the skin tissue for effectively recruiting sensory fibers.

As the understanding of the topographical organization of nociceptivesystems becomes more detailed, the target location of the stimulation,the percutaneous electrodes' depth of penetration, and the currentamplitude become more exacting. Percutaneous neuromodulation therapy(PNT) and cutaneous field stimulation (CFS) are specific forms of PENSthat have been developed using that understanding. PNT is used for thetreatment of cervical and lumbar pain and utilizes longer,acupuncture-type needles having a depth of penetration into the skintissue of up to 3 cm. CFS is used more generally to treat pain and itchand utilizes an array of microstructure needles introduced close to thenerve endings in the skin. Because of the stringent requirementsestablished for needle electrodes by the Food and Drug Administration(FDA) regarding the packaging, sterilization, reuse, and disposal ofsuch electrodes, treatments utilizing such electrodes have generallybeen administered under the supervision of a physician (e.g., in adoctor's office or a clinic).

CFS is used to assist in the management of chronic nociceptive andneuropathic pain based on the understanding that specific types ofsensory nerves that are linked to diminishing the perception of pain canbe activated by low amplitude, long duration electrical stimulation ifelectrodes having sharp tips (i.e., microstructure needles) areintroduced close to the nerve endings in the skin. CFS treatment alsoinfluences specific active components necessary for perceiving itch byinducing long lasting inhibitory mechanisms in central pathways and byactually normalizing the number of epidermal sensory fibers in itchyskin. Accordingly, CFS also provides an alternative to known treatmentsfor localized itch.

The sensory receptors stimulated by CFS are axons within the skin tissueknown as nociceptors, specifically Aδ and C nerve fibers. Thestimulation of Aδ and C nerve fibers, although effective in diminishingthe perceptions of both pain and itch, can be a relatively uncomfortabletreatment because a prickling and/or burning sensation is perceived fromthe stimulation of the Aδ and C nerve fibers, which can be uncomfortableand painful. Because the aversiveness of Aδ and C nerve fiberstimulation can be masked by Aβ fiber stimulation, it would be aconsiderable advantage to combine Aδ fiber stimulation (e.g.,transcutaneous electrical nerve stimulation (TENS)) and Aδ and C fiberstimulation (e.g., CFS) in the same equipment. Accordingly, there is aneed for a method and device that combines Aβ fiber stimulation and Aδand C fiber stimulation in one treatment. Moreover, there is a need fora method and device that combines TENS and CFS in one treatment.

Cutaneous Field Stimulation (CFS) is a technique for relieving itch andpain that allows topographically restricted and tolerable electricalstimulation of thin (Aδ and C) cutaneous fibers but is not well suitedfor the stimulation of Aβ fibers. CFS uses a flexible plate withmulti-array needle-like electrodes regularly fixed at 2-cm intervals.Each electrode is surrounded by an elevated “stop-device” about 2.0 mmin diameter that protrudes 2.0 mm from the plate. The electrode tipusually protrudes 0.3 mm to 0.4 mm from the stop-device. When gentlypressing the electrode plate against the skin, the electrode tips areintroduced close to the receptors in the epidermis and the superficialpart of dermis. Since the electrodes traverse the electrically isolatinghorny layer of the epidermis and the current density is high near thesharp electrode tips, the voltage and current required for stimulatingcutaneous nerve fibers are small, typically less than 50 V and up to 2mA, respectively. As the current density decreases rapidly withdistance, localized stimulation is achieved. The electrodes arestimulated consecutively with a constant current stimulator, eachelectrode with a frequency of 1-10 Hz (pulse duration 1.0 ms) andtreatment duration of 5-45 min. In its original embodiment, aself-adhesive surface (TENS) electrode served as anode and was usuallyplaced about 5-30 cm away from the needle electrode plate.

Recent improvements in CFS are taught, e.g., in U.S. Pat. No. 8,086,322.However, it would be helpful to provide a CFS system that is lessexpensive and more easily used than present systems.

CFS works best on pain or itch that is focused in one main area.Therefore, one of the challenges of using CFS for itch or pain that isnot focused in one particular area is the distribution of the signal.CFS is most effective when placed directly over the area of pain oritch. Therefore, pain or itch that is distributed over multiple areasrequires repeated use of the stimulator serially in each zone of pain oritch. Having a system that would allow simultaneous stimulation ofmultiple sites with an easy to use interface would be advantageous.

SUMMARY OF THE INVENTION

It is therefore an object of the invention, in at least someembodiments, to provide a system using less expensive pads.

It is another object of the invention, in at least some embodiments, toprovide such a system that is easier and more convenient for the patientto use.

It is still another object of the invention, in at least someembodiments, to provide such a system that uses, as its controller, adevice that the patient will likely already own, such as a smartphone.

To achieve the above and other objects, the present invention, in atleast some embodiments, is directed to a CFS system havingself-adhesive, disposable pads. Each pad is combined with a sealed,cleanable battery/controller pod and then placed on the body whereneeded.

The battery/controller pod preferably has wireless capability, such asBluetooth® capability. The patient can download an application to asmartphone or similar mobile device (e.g., iPhone, iPad, or Androidsmartphone). The application guides the patient in the placement of thepads and then controls the smartphone or other mobile device to connectwith the battery/controller pods wirelessly and to act as a centralcontroller for the battery/controller pods. The use of that applicationallows both easy upgradability and a user-friendly graphical userinterface and also makes use of a device that the patient likely alreadyhas and with which the patient is familiar.

The patient is also provided with an inductive charger for thebattery/controller pods. The inductive charger can also have cleaningcapability. Once the treatment is over, the patient discards the padsand places the pods into the charger.

A CFS system that has multiple channels with a fewer number of needlelike (NL) electrodes per electrode plate (4 to 6 instead of 14 to 16)could be tailored to more effectively treat each zone of pain or itch bytitrating the level of stimulation or amplitude for each channel orzone. The size of the treatment zone could also be increased ordecreased by adding multiple disposable electrode plates to match thesize of the pain or itch zone. The level of stimulation or amplitude ofeach electrode plate could be individually adjusted and tuned to providethe optimal amount needed at each zone. Using a remote controller (e.g.,a smartphone) to adjust the output and parameters of each zone andconnecting the controller with each of the electrode plates usingBluetooth or other wireless technology would greatly increase theconvenience and ease of use of the CFS system. This type of CFS systemwould provide a more effective and easier to use treatment of pain anditch due to its scalability, convenience and adjustability.

BRIEF DESCRIPTION OF THE DRAWINGS

A preferred embodiment of the present invention will be set forth indetail with reference to the drawings, in which:

FIG. 1 is a drawing showing the configuration of a pad;

FIG. 2 is a drawing showing a retail package in which the pads are soldto the patient;

FIG. 3 is a drawing showing the way in which the pad and the pod arecombined for use;

FIG. 4 is a schematic diagram showing the circuitry in the pod of FIG.3;

FIG. 5 is a drawing showing the way in which the pods are placed intothe charger after use;

FIG. 6 is a drawing showing the smartphone running the CFS application,the communication between the mobile device and the pads, and theplacement of the pads on the patient's body;

FIGS. 7A through 7L are diagrams showing steps in the use of the CFSsystem;

FIG. 8 is a drawing showing a possible modification of the pads;

FIG. 9 is a drawing showing one possible configuration for the charger;

FIG. 10A is a perspective view showing another possible configurationfor the charger;

FIG. 10B is a cross-sectional view taken along lines XB-XB of FIG. 10A;and

FIG. 11 is a drawing showing another possible modification of the pads.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

A preferred embodiment of the present invention and variations thereofwill be set forth in detail with reference to the drawings, in whichlike reference numerals refer to like elements or steps throughout.

FIG. 1 shows a pad 100 according to the preferred embodiment. The pad100 includes a substrate 102 carrying a flexible circuit 104, TENS pads106, and CFS needle electrodes 108. An adhesive 110 is applied to allowadhesion to the patient's skin, and a cover 112 (not shown in FIG. 1,but shown in FIG. 7B) is disposed on the pad 100. The flexible circuit104 has a portion 114 formed in a pocket 116 in the substrate 102 toreceive power from a pod (to be described below).

The pad 100 is consumable, disposable, and self-adhesive. It has aflexible circuit, one-use gel pads, and one-use CFS needle electrodes.

FIG. 2 shows multiple pads 100 in an over-the-counter consumer 12-pack200 having a sheet 202 and an envelope 204. Of course, the pads 100could be packaged singly or in any number, and the configuration of thepackaging can be changed as desired as long as the pads 100 areadequately protected.

FIG. 3 shows a pod 300 for use with the pad 100. The pod 300 is reusableand rechargeable and is inserted into the pocket 116 of the pad 100. Thepod 300 can have a surface antimicrobial treatment to assure cleanlinessand decrease any possibility of contamination. In addition, or instead,a disinfecting device, to be described below, can be used, or the podscan be wiped with disinfecting cloths between uses.

FIG. 4 is a circuit diagram showing the circuitry contained in the pod300. The pod 300 contains a 3V battery 402 and output circuitry 404 forproviding a 50V output. The battery 402 has a life of 20 minutes andoperates under control of a microelectronic controller 406 and aBluetooth communication device 408. Of course, any suitable values andany suitable communication protocol could be used instead.

FIG. 5 shows an inductive pod charger 500 into which multiple pods 300are inserted for inductive charging.

FIG. 6 shows multiple pads 100 placed on the back of a patient P. Asuitably programmed smartphone or other wireless device 600 communicateswith the pods (not shown in FIG. 6) using a Bluetooth connection 602.

FIGS. 7A through 7L show steps in the use of the preferred embodiment.In FIG. 7A, the patient P is suffering from lower-back and shoulderpain. In FIG. 7B, the patient P peels off the cover 112 from the pad 100and inserts a battery/controller pod 300. In FIG. 7C, the patient Pplaces a pad, with the pod inserted, at each pain zone. In FIG. 7D, thepatient P runs the smartphone application on the smartphone 600 andselects the transducer locations on the application's graphical userinterface 702. The application can also prompt the patient on where toplace the pads using diagrams or photographs taken by the doctor at theinitial appointment. Of course, the order of performing the steps ofFIGS. 7B-7C and the step of FIG. 7D could be reversed. In FIG. 7E, thepatient P chooses a treatment program for each zone on the graphicaluser interface 702. The programs can be custom-designed by the user andsaved and named if liked, or the doctor can set and lock each program.In FIG. 7F, the patient P presses the “Start Treatment” button 704 onthe graphical user interface 702. The graphical user interface 702 canshow intensity, program curves, and the like. The application can alsoplay music or video or allow the patient to play a game. In FIG. 7G, thepods 300 and the smartphone 600 communicate wirelessly over theBluetooth connection 602 to control each pod 300 to load and start theappropriate treatment to the zone where it is located. In FIG. 7H, thetreatment programs are running, and the patient P can relax duringtreatment. In FIG. 7I, the treatment programs are finished, and thepatient P removes each pad 100 and removes each pod 300 from itscorresponding pad. In FIG. 7J, each pad, which is intended for a singleuse, is discarded. In FIG. 7K, the pods 300 are placed into an inductivecharger 500. In FIG. 7L, the process ends, and the patient's pain isrelieved.

The application can wirelessly transmit information after each treatmentto the doctor for the patient's file. The details can include duration,program setting, date and time. The application can also provide regularreminders to help the patient tailor and follow treatment guidelines asfits the patient's schedule. Communication with the doctor's office canbe by any suitable communication technology, e.g., the data connectionor SMS functionality in the smartphone 600.

The use of a smartphone or tablet means less physical product to track,produce, repair, or update, since the application can be implemented onhardware that the patient likely already has. Alternatively, a dedicateddevice can be produced. Product updates can largely be done by releasingupdates of the application. Such updates can upgrade the look/feel andperformance of the user interface and the programs.

The product will conform to the patient's aesthetics because the patienthas already chosen the device and the cover. The user interface can alsoinclude options to customize such things as the color schemes.

Small, independent transducers (pad/pod combinations) make placement,coverage, and focus easier. In a variation of the preferred embodiment,shown in FIG. 8, changeable color-coded rings 800 provide a visualreference for placement and program options in the user interface.

FIG. 9 shows an example of an inductive charging pad 500. The chargingpad 500 has a dimple 902 into which each pod 300 can be snapped forcharging. Some sort of contact charging can be provided instead.

FIGS. 10A and 10B are a perspective view and a cross-sectional view,respectively, of a charging box 1000 that charges one side anddisinfects the other side simultaneously. The box 1000 includes aninductive charging mat 1002 and a capillary foam 1004 for applying asterilization fluid 1006 to the pod 300.

FIG. 11 shows multiple sheets 1100 to keep different colored transducers1102 separate. This can be useful if, for example, different types oftransducers are provided.

While a preferred embodiment and variations thereon have been set forthin detail above, those skilled in the art who have reviewed the presentdisclosure will readily appreciate that other embodiments can berealized within the scope of the invention. For example, numericalvalues are illustrative rather than limiting, as are disclosures ofspecific technologies, technical standards, and methods of charging thepods. Therefore, the present invention should be construed as limitedonly by the appended claims.

What is claimed is:
 1. A device for cutaneous field stimulation, thedevice comprising: a sealed and cleanable battery/controller podincluding at least one battery; and a disposable pad that is configuredsuch that the pod is insertable into a pocket of the pad, the padcomprising: a substrate; a plurality of TENS pads on the substrate,wherein the plurality of TENS pads generally surround the pocket; aplurality of CFS needle electrodes on the substrate; and circuitry onthe substrate for conveying power from the pod to the plurality of TENSpads and the plurality of CFS needle electrodes, and the circuitryextends through the pocket to engage the pod.
 2. The device of claim 1,wherein the pod comprises a microcontroller.
 3. The device of claim 2,wherein the pod further comprises a communication device for wirelesscommunication between the microcontroller and an external device.
 4. Thedevice of claim 1, further comprising a charger for the pod.
 5. Thedevice of claim 4, wherein the charger is an inductive charger.
 6. Thedevice of claim 4, wherein the charger comprises a component fordisinfecting the pod while charging the pod.
 7. A system for cutaneousfield stimulation, the system comprising: a processing device; aplurality of sealed and cleanable battery/controller pods, each of thepods including at least one battery and each of the pods beingconfigured for wireless communication with the processing device; and aplurality of disposable pads that are configured such that each pod isinsertable into a pocket of one of the pads, each of the pads comprisingTENS pads and CFS needle electrodes, wherein the TENS pads generallysurround the pocket of the pad, wherein each pad has circuitry on asubstrate for conveying power from the pod to the TENS pads and the CFSneedle electrodes, and the circuitry of each pad extends through thepocket to engage the pod; wherein the processing device is configured tocontrol the pods over the wireless communication to implement thecutaneous field stimulation.
 8. The system of claim 7, wherein theprocessing device is a smartphone or tablet running an application forcontrolling the pods.
 9. The system of claim 7, wherein the padscomprise at least two sets of pads, the at least two sets of pads beingcolor-coded with different colors.
 10. The system of claim 7, whereineach of the pods comprises: a microcontroller; and a communicationdevice for wireless communication between the microcontroller and theprocessing device.
 11. The system of claim 7, further comprising acharger for the pods.
 12. The system of claim 11, wherein the charger isan inductive charger.
 13. The system of claim 11, wherein the chargercomprises a component for disinfecting the pod while charging the pod.